determine the prevalence of disease-carrying mosquitoes and control measures were applied when necessary. At several seaports, ships were inspected for the same purpose. SPECIAL PROBLEMS Smuggling of psittacine birds into the United States continued to present a major problem in the control of parrot fever. During the year, shipments of more than 3,000 birds, which had been smuggled across the Mexican border, were seized in California. A United States Customs agent acquired psittacosis from handling these birds. Laboratory tests indicated that the infection was present in a large proportion of the smuggled birds, all of which were thereupon destroyed. Foreign quarantine regulations were amended to require the destruction or deportation of birds which, during shipment, have been exposed to psittacosis, or have been in contact with birds showing symptoms suggestive of the disease or dying of unconfirmed causes. The regulations now include zoological parks among other establishments forbidden to import psittacine birds for sale or trade to the public or to dealers in birds. REVISION OF REGULATIONS Foreign quarantine regulations have been revised to conform with international sanitary regulations, promulgated by the World Health Organizations in 1951 and effective October 1, 1952. The new regulations include the earlier requirements under United States law concerning smallpox vaccination. Regulations for medical examinations have been revised primarily to conform with the health provisions of the new Immigration and Nationality Act, effective December 24, 1952. Hospital Survey and Construction Program The construction phase of the Hospital Survey and Construction Program has been in operation 6 years. More than 1,200 hospital projects and related health facilities have been completed by States and communities throughout the Nation with the aid of funds provided under the Hospital Survey and Construction Act. This law is administered by the Division of Hospital Facilities. The annual revisions of the State Plans on file June 30, 1953, indicated that the States and Territories now have 1,059,816 acceptable hospital beds. The States further reported that they need 848,678 additional beds to provide adequate hospital care for the Nation's total population. The Congress made available $75 million for hospital construction to help meet these needs in 1953. The number of projects approved under the program increased from 1,827 on June 30, 1952 to 2,104 on June 30, 1953. During the year the one-thousandth project completed under the program was put into operation. By the end of the year 1,229 projects were in operation, 727 were under construction, and 148 were reported to be in "blueprint" stages. The total cost of these completed and approved projects is $1,688,000,000, of which the States and local communities contributed over $1 billion, and the Federal Government $583 million. About 75 percent of the projects are general hospitals, providing 82,621 beds. Public health centers account for 16 percent, while the remaining 9 percent are mental, tuberculosis, and chronic disease hospitals with a total of 19,700 beds. The reports of the States show that the program is helping to meet the most urgent needs for hospital facilities and is making a contribution to the needed expansion of the Nation's medical education facilities. Nearly 800 of the approved projects are for completely new general hospitals in communities previously without hospitals or with inadequate facilities. Nearly three-fifths of the new hospitals are in communities of less than 5,000 population and about the same proportion are small buildings of less than 50 beds. About 170 larger projects are providing teaching hospitals for the training of interns and medical residents. An additional 21 projects provide other medical education facilities in 18 States. The teaching hospitals and related facilities have received about $114 million in Federal funds, or a little more than one-fifth of the total amount made available to date. The vital role of these institutions is the training of physicians, nurses, and other personnel who are needed to staff the small hospitals and health centers in rural areas, as well as the larger facilities in larger communities. During the year, the Division of Hospital Facilities and the State Hospital Agencies cooperated in a survey of new general hospitals which had been constructed with Federal aid and in operation one or more years. The objective was to appraise many aspects of the National Hospital Survey and Construction Program, specifically to determine whether the new hospitals were satisfying the needs of their communities. The study showed that 200 new community hospitals, constructed with Federal aid, were providing a more extensive range of services than facilities of comparable size, type, and ownership which had been constructed in the same geographic areas without Federal aid. The Division represented the Public Health Service in administering the provisions of the Defense Housing and Community Facility Services Act of 1951 for the construction of hospital facilities. Six projects were approved for $1,630,238 in Federal funds to construct hospitals in Hermiston, Ore., Orangeburg, S. C., San Diego, Calif., Moses Lake, Wash., Leonardtown, Md., and Moline, Ill. The Nation's Nursing Resources During 1953, the Division of Nursing Resources assisted 9 States in their studies of nursing service needs and nursing personnel and it supplied consultation to the National League for Nursing, the American Hospital Association, and the Health Resources Advisory Committee of the National Resources Council. In addition the Division completed several major studies in the fields of nursing administration, education, and statistics. TRENDS IN NURSING PERSONNEL In collaboration with the Division of Public Health Methods, the Division completed the tabulation and analysis of data on trends in nursing personnel, covering the years 1910 to 1950. The report brings together for the first time data from such sources as the U. S. Bureau of the Census, the Department of Health, Education, and Welfare, the American Medical Association, the American Hospital Association, and the professional nursing associations. This study shows what has been happening to the nurse supply in the United States during the first half of the Twentieth Century. For example, the ratio of active graduate nurses to population in 1910 was 55 per 100,000 and has increased every decade to 249 per 100,000 in 1950. The rate of increase, however, has slowed markedly since 1930. The ratio in 1930 was 79 percent greater than in 1920, whereas the 1950 ratio was only 15 percent in excess of that of 1940. The report also includes data on the licensure and education of practical and professional nurses; six fields of professional nursing; interstate migration of nurses; and the numbers of graduate and student nurses by States. STATE NURSING SURVEYS Statewide surveys and programs to increase nursing resources were conducted in Colorado, the District of Columbia, Maine, Michigan, New Mexico, New York, Texas, Utah, and West Virginia. Typical results of these surveys may be observed in Texas. The Committee for the Improvement of Nursing Service in Texas is promoting four methods of making more nursing service available. These are: group private duty nursing; team nursing; continuity of care from hospital to home; and studies of nursing functions. In the last project, 19 hospitals in Texas are making studies of head nurse activities with a view to more effective utilization of nursing skills. The University of Texas has enrolled 375 graduate nurses in extension courses designed to increase their qualifications. Michigan is the first State to try out a permanent system for continuous appraisal of the nurse supply, which the Division of Nursing Resources has recently developed. Utilization studies have been made by three Michigan hospitals to determine how the assignment of nursing personnel affects the amount and kind of service reaching patients. A group of general, tuberculosis, and mental hospitals also participated in job satisfaction studies designed to provide guide lines for recruitment and personnel administration. RURAL EXPERIENCE FOR STUDENT NURSES The Division has undertaken to develop a method whereby nurse educators can determine the types of illnesses cared for in small hospitals and thus select more effectively the institutions which will give their students valuable rural experience. The Medical College of Virginia and the Virginia State Hospital Association are testing the method in 27 hospitals of varying sizes. INSTRUCTION FOR NURSING AIDES At the request of the Health Advisory Resources Committee, the Division has prepared and tested a handbook for the instruction of nursing aides in hospitals. The book is to be published in cooperation with the American Hospital Association and the National League for Nursing. The procedures outlined in the handbook were selected after careful analyses of the duties that aides are most frequently expected to perform in small and medium sized hospitals. The educational methodology was based on recommendations of the Office of Education and authorities on training-in-industry. A month's practical trial at the Phoenix Medical Center of the Bureau of Indian Affairs met with enthusiastic response. Dental Resources The Division of Dental Resources continued to focus attention on the supply, distribution, and utilization of dental manpower. In addition to conducting and collaborating in studies, the Division also served as a center for information on dental health needs and resources. SUPPLY OF DENTISTS Existing information on the Nation's supply of dentists does not readily lend itself to analysis below the State level with respect to the individual dentist's field of specialization and his years in practice. The Division, in cooperation with the Division of Public Health Methods, is therefore compiling detailed data of this type which will permit local planning agencies to study dentist distribution in connection with civilian defense or public health needs. When this basic material has been tabulated, the Division will conduct a broad study of dentist supply in relation to trade areas and community characteristics. An analysis of this type will also throw light upon the extent to which the present distribution of dentists is influenced by location of dental schools. UTILIZING DENTAL MANPOWER AND FACILITIES The Division continued to appraise the value of the use of multiple chairs and auxiliary personnel as a means of increasing the productivity of the individual dentist. In the interest of improving the dentist's operating efficiency, the Division has provided consultation in the design and development of a modernized dental cabinet which is now in production by private industry. The chief assets of the new cabinet are automatic drawers that open and close without the use of unhygienic drawer-pull knobs; a dust proof interior; and instrument trays and bottle holders of modified design which can readily be cleaned. DENTAL EPIDEMIOLOGY The dentofacial index (DFI), an epidemiologic concept developed by the Division, is being used to establish age- and sex-specific patterns of dentofacial deformity. The DFI shows promise as a scientific tool for determining the incidence and prevalence of these deformities in large populations. Efforts during the past year to find factors influencing malocclusions have led to the tentative conclusion that dental caries is not a primary agent in the etiology of malocclusion. Medical and Hospital Resources The Division of Medical and Hospital Resources was abolished at the close of the fiscal year 1953. A number of projects were completed and studies in progress were taken over by other Divisions. An extensive report on the need for general hospital beds was completed and is being published. A compilation of State laws and regulations on the licensure of hospitals also was completed. The inventory of nursing homes was continued in order to maintain a current list of the nursing homes and the responsible State agencies in the United States and Territories. The Division provided consultation to the Bureau of Public Assistance, the National Committee on Aging of the National Social Welfare Assembly, Inc., and the Commission on Chronic Illness. The Division also continued to stimulate and participate in informational programs for hospital |